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About WIN Pamoja

What is WIN Pamoja ?

WIN Pamoja in a Kenyan company that is making it Convenient, Affordable and Secure for Diaspora to Signup for services in Kenya. WIN Pamoja means (“WIN” from the word “Winning” and “Pamoja” from the Kiswahili word “Together”).

Our business model and choice of products has been founded on feedback that we have gathered over the years from the Diaspora. Our first engagement with the community took place in October 2011 at the 1st Diaspora conference where we carried out our 1st Diaspora Survey. We have since continued to ask questions and to listen to Diaspora.

WIN Pamoja has offices in Nairobi, Kenya and are therefore able to "run errands” on behalf of the Diaspora including submitting Applications and collecting the Policy feedback.

Is WIN Pamoja an Insurance Company ?

No, WIN Pamoja is a Kenyan company that in offering a Platform through which Diaspora can connect to important services in Kenya.

Who can open a Policy – “The Policy Holder”

Who can signup for this Life Insurance (The Policy Holder)

Diaspora can signup. They will use it to insure their family members living in Kenya

About the Product – Life Insurance

What is this Life Insurance Product

This is Life Insurance which means that the Policy Holder can make a Claim upon the passing of an Insured family member.

The underwriter of the Policy is APA Insurance Company which is an Insurance company based in Kenya.

This product is available for Diaspora to insure their family members in Kenya. This product does not insure Diaspora.

The “Policy Holder” will be the Diaspora.

“The Insured” is their family member.

The "Underwriter" who is also the payer of Claims is APA Insurance Company.

WIN Pamoja is the channel/platform through which the applications, annual renewals and Claims are submitted.

The Policy is valid for 1-year and is renewable annually. Failure to renew on time will result in the Policy Expiration. To “renew” an Expired Policy means that you would be submitting a new application which will be subject to the Terms and Conditions at the time of submitting again.

These Terms and Conditions for this Life Insurance Policy are subject to change at anytime and without notice by APA Insurance.

Why signup for Life Insurance ?

The Life Insurance Claims offer financial relief after the passing of a family member. The Claims made can be used to cover funeral expenses, travel related expenses and even educating Children of the deceased.

Who can be insured – “The Insured”

Which Family members can Diaspora insure? (The Insured)

Diaspora can insure their family members living in Kenya. Diaspora cannot insure family in the Diaspora.

The Insured family members should be Husband/Wife, Parents, Children, Brother, Sister, Grandchildren and Grandparents.

Why are we insuring siblings, Grandparents and Grandchildren

Why are we also insuring Brothers and Sisters - WIN Pamoja did multiple Diaspora surveys that revealed that after bereavement, Diaspora educate children of their deceased siblings. We therefore felt that it would be helpful to provide the option for Diaspora to insure siblings.

Why insure Grandchildren - Diaspora would want to manage funeral expenses for the families of their children that live in Kenya.

Why insure Grandparents - Diaspora may be expected to contribute towards the funeral expenses of their Grandparents.

Which Family members should NOT be insured under this Policy ?

Family members that live in the Diaspora.

In-laws – They should be insured through your spouse.

Step/half brothers and sisters – They should not be insured because you would need to show evidence of the relationship during Claims.

Evidence of Relationship

During Claims, APA insured can request evidence of the relationship. Evidence provided should be government issued identification including Birth Certificates, Identification Cards, Passports and Marriage Certificates.

Location and Relocation

“The Insured” must be a family member that lives in Kenya. If The Insured relocates out of Kenya, the Policy can continues to be renewed annually.

“The Policy Holder” is the Diaspora. If the Diaspora relocates back to Kenya, the Policy can continue to be renewed annually.

Maximum number of insured family per Diaspora

Is there a maximum number of people that can be insured

Diaspora have unlimited family members that can be signed up, however they must be 1-Spouse, 2-Parents, Children, Siblings, Grandchildren and 4-Grandparents.

Please remember that evidence of relationship can be requested by the Insurance Company during Claims.

Age Limit

Is there an Age Restriction ?

This policy requires enrollment of the Insured before they turn 75 years. This Policy also covers The Insured upto 85 years.

This means that the initial (1st) enrollment of the Insured must be completed before they turn 75 years. After the Policy has been issued, the Policy can be renewed annually even after the Insured turns 75 years.

This Policy is renewable annually (each year) until the Policy Holder becomes 85 years. At 85 years, the Policy will automatically be cancelled and will no longer be renewable. No Claim shall be paid against a Cancelled Policy.

Health Status

No medical checkup is required for Diaspora to insure their family members, however the Insured must be in good health standing.

No Applications should be submitted for family members that are NOT in good health standing, is undergoing medical treatment, is experiencing health challenges or has a history of medical issues. Failure to disclose Health conditions will cancel the contract.

APA Insurance does investigate after Claims are paid to confirm if the Insured was in good health standing at the time of initial enrollment. If they find that payments were under false information, WIN Pamoja will be held responsible for the inaccurate information. So please do not enroll any family that is not in good health standing.

6-Months Waiting Period

The Policy is effective on the 1st day, however Claims can only be paid if death occurs atleast 6-months after the initial Policy is issued. This means that if The Insured passes during the 6-months Waiting Period, no claim will be paid.

If the Insured person passes during the initial 6 months of the Policy, no Claim will be paid out.

Maximum payable Claim against a Death Certificate is Kshs 1,500,000.

APA Insurance can pay more than 1-Claim on the same Insured Family member, however total Claims paid out will NOT exceed Kshs 1,500,000/.This means that if multiple Diaspora have insured a family member, then each Policy Holder will be paid Kshs 500,000/- but total payment by APA Insurance will NOT exceed Kshs 1,500,000/ against the death certificate.

Example 1

Mzee John lives in Kenya. He is insured by his Wife, Daughter and Son who all live in the Diaspora. Therefore Mzee John has 3 Policies that have been issued against him.

Scenario 1 - In the event of his passing of Mzee John, each of the 3 Diaspora can submit a Claim. Each will be paid Kshs 500,000/- for the Claim.

Scenario 2 – If Mzee John had been insured by more than 3 Diaspora, since the maximum payable Claim amount from APA Insurance is Kshs 1,500,000, then this amount will be divided equally among each of the Policy Holders. Each Policy Holder will therefore receive less that Kshs 500,000.

WIN Pamoja must therefore be notified of a Claim within 14 days so they can process the immediately.

Expired and Cancelled Policies

The Policy is Valid for 1-year. This means that the Policy will not be valid after 1-year unless it is renewed.

Renewal of Policies requires that APA Insurance receive your renewal application atleast 14 days prior to expiration. Failure to renew on time does not guarantee renewal.

Expired Policy – this means the Policy has passed the expiration date and was not renewed by APA Insurance. Once a Policy is Expired, it means that:

No Claims will be paid against an Expired Policy.

Once a Policy is expired, any new Policy issued would be under new Terms and Conditions.

You are “The Policy Holder” – To open an account, please submit a New Account Opening Form that includes your Name, Email, Phone, Address and a copy of your Kenya ID or Passport.

The Policy will list your Names. In the event of a Claim, you will be required to provide ID that matches the Policy information.

Sign your Family into your WIN Pamoja account

Your family member is “The Insured” – Please submit their Name + Date of Birth onto your WIN Pamoja account.

The Policy will list the family member Name and Date of Birth as you have provided.

No Family member ID copy is required during the Application process, however the Family member ID Copy must be provided during ClaimsPlease ensure that the information you provide is accurate because in the event of a Claim, you will be required to provide ID that matches the Policy information.

No family member Medical Checkup is required during application, however the Insured family member must be in good health standing. No Applications should be submitted for family members that are NOT in good health standing, is undergoing medical treatment, is experiencing health challenges or has a history of medical issues.

Payment is paid for the full year. No partial or monthly payments are accepted.

What does it cost (The Premium) ?Insurance costs is KES 6,000 (estimate $60) per person per year. This will give coverage of KES 500,000.

What coverage do you get (The Coverage) ?The Insured receives a Coverage of KES 500,000. This means that if the Insured person passes on, then the Policy Holder can claim KES 500,000.

What are the Administrative Fees ?The Administrative Fee is Kshs 1,000 per Policy application. This is also charged during annual renewals.

Claims

What is a Claim (The Claim) - Upon passing of The Insured, the Policy Holder can claim the KES 500,000 (estimate $5,000). When approved, the Claim is paid by APA Insurance to the Policy Holder.

Who can make a Claim (The Claim) - The Policy Holder is the only one that can make a Claim. No Policy or Claims information is provided to representatives due to confidentiality.

Notification of Passing of a family member

The Policy Holder must notify WIN Pamoja within 14 days of the passing of your family member.

The Claims Process

WIN Pamoja will provide you with a Claim Form.

The Claims process begins once the completed Claim Form and required documents are submitted to APA Insurance.

Original Death Certificate

Deceased’s Government issued Identification – This can include National Identification Card, Passport OR Birth Certificate (for Children under 18 years).

Policy Holder’s Kenya ID or Passport.

Documents provided must NOT be expired.

Documents provided must match the Policy Holder Name, Deceased Name and Deceased date of birth.

Claims submitted after 60 days after the passing of The Insured will be disqualified from payment.

Payment of Claims

Payment will be made directly from APA Insurance to the Policy Holders Banks Account in Kenya

Circumstances under which Claims are not paid - Claims are not paid if the death occurs under the following circumstances:

When death occurs during the 6-months Waiting Period

When Claim is requested against an Expired Policy or Cancelled Policy

When death is due to Alcohol / illegal drugs / Narcotics / Substances (except prescribed)

When death is due to Suicide

When death is the result of optional participation in a high risk activity that caused bodily harm (example fights, accidents due to a high risk activity)

When death occurred while performing an intentional criminal offence (example burglary)

When death is the result of being a victim of war

NOTE: Maximum Claims Paid out against a Death Certificate is Kshs 1,500,000. This means that when multiple Claims are submitted by different family members for the same Insured family member that has passed, the maximum Claim payout will be Kshs 1,500,000.

When 4 or more Claims are submitted against the same Death Certificate, then Ksh 1,500,000 will be distributed equally amongst all the Policy Holders that submitted a Claim.

The Bank Account

Policy Holders Banks Account must be in Kenya

Bank Account Name must match the Policy Holder’s name.

If you do not have a Bank Account in Kenya, WIN Pamoja recommends that you do not open a bank account at this time – until at the time of making a Claim. During Claims, WIN Pamoja can provide some tips on how to open a bank account in Kenya.

*This Terms and Conditions from APA insurance are subject to change anytime without notice.